Re: Post Partum D and C's for retained placenta- ultrasound result
From: Greg Kesby (greg.kesby@sufw.com.au)
Fri Jan 9 11:13:55 2004
I think the e-nail said she had the scan yesterday
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-----Original Message-----
From: Tom Kavic Direcpc [SMTP:tak@direcpc.com]
Sent: Friday, 9 January 2004 4:26:PM
To: Multiple recipients of list ULTRASOUND
Subject: Re: Post Partum D and C's for retained placenta-
ultrasound result
I would not only treat the patient as per clinical findings but
would not
hesitate to get pelvic sonar at some point so that no surprises may
be overlooked in a patient with
possible retained products of conception.
T. Kavic , M.D., RVT, RDCS, RDMS
>----- Original Message -----
From: "Greg Kesby" <greg.kesby@sufw.com.au>
To: "Multiple recipients of list ULTRASOUND"
<ultrasound@dns.obgyn.net>
Sent: Thursday, January 08, 2004 6:07 PM
Subject: Re: Post Partum D and C's for retained placenta- ultrasound
resul t
> Treat the patient not the scan. At now (3-4 weeks) postpartum, if
she is
> fine and happy with life and the trend is for things to be
improving, I
> would leave her alone in the absence of a definite clump or RPOC
>
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> -----Original Message-----
> From: jmsmed58@hotmail.com [SMTP:jmsmed58@hotmail.com]
> Sent: Friday, 9 January 2004 8:42:AM
> To: Multiple recipients of list ULTRASOUND
> Subject: Re: Post Partum D and C's for retained placenta-
> ultrasound result
>
> Hi Greg.
>
> This patient below went to get an ultrasound. The
ultrasonographer
> could definitely see that there was still fluid and debris in the
> uterus.... How much she didnt say. The results from the
ultrasound
> will be delivered to the Dr tomorrow.
>
> The per vaginal bleeding has really slowed down and is starting
> to look like its clearing up.
>
> So Greg, what would be your advice in this situation? Would you
> still go
> the conservative way?
>
> Interested to know what you think
>
> Regards
>
> Joanne
>
> At Wed, 7 Jan 2004, Greg Kesby wrote:
> >
> >As an Aussie sonologist and MFM, what you describe is pretty
> standard (and
> >in my view good) practice. We are a little more conservative with
> regard the
> >use of curettage.
> >
> >While aware of the limited utility of sonography in the setting
of
> RPOC 2
> >weeks postpartum, we use it to ensure that there is not a large
> amount of
> >RPOC.
> >
> > Then, in the setting of a confirmed small volume or none
> >sonographically evident, antibiotics and "let nature take its
> course" is a
> >very common practise.
> >
> > Her management sounds excellent.....avoided a GA and curette
> with
> >its possible associated morbidity and just had to put up with
> passing a
> >small amount of placenta 2 weeks post partum.
> >
> > Cheers
> >
> >Greg
> >
> >CONFIDENTIALITY NOTICE:
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> recipients only.
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are
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> >
> > -----Original Message-----
> > From: jmsmed58@hotmail.com [SMTP:jmsmed58@hotmail.com]
> > Sent: Wednesday, 7 January 2004 8:54:AM
> > To: Multiple recipients of list ULTRASOUND
> > Subject: Post Partum D and C's for retained placenta
> >
> > Hi
> >
> > I would like to know pracitioners opinion on the value of
> doing an
> > ultrasound if a patient has passed Is the ultrasound
> examination
> >going to pick up small
> > amounts of retained products?
> > If it isnt then why not just do a D and C.
> >
> > This particular patient had some retained placenta. A small
> amt
> > discharged 2 weeks post partum. She called the hospital who
> did the
> > delivery and they said get some antibiotics. Not being
> happy with
> >that
> > she went to a local GP (In Australia they are M.D's) and the
> >following
> > was done: vaginal swab, an ultrasound was ordered and
> antibiotics
> >were
> > prescribed to be taken before the results of ultrasound came
> >through. A
> > possiblity of a D and C was mentioned at the time of
> appointment.
> >So,
> > having said what this person's history is, how valuable is
> the
> > ultrasound going to be? Shouldnt this doctor just go ahead
> and order
> >a D
> > and C without further ado?
> >
> > Looking forward to your replies
> >
> > Regards
> >
> > Joanne
